Medical Professionals Endorse WHO Checklist For Safer Surgery

A new safety checklist for surgical procedures developed by the World Health Organization (WHO) won the endorsements of nearly 250 health organizations from over 40 countries at a launching event yesterday at the Pan American Health Organization (PAHO) in Washington, D.C.

The endorsements include "70 professional associations, ministries of health and hospitals from 29 countries in the Americas," said PAHO Director Mirta Roses. "Our participation in 'Safe Surgery Saves Lives' is an important step to bring forward the patient safety agenda in the Americas."

The new Surgical Safety Checklist, from WHO's World Alliance for Patient Safety, offers simple step-by-step guidelines that surgical teams should follow before and after any operation to ensure patient safety. The guidelines range from making sure the right patient is being operated on at the right body site to estimating the amount of blood loss that can be expected. WHO estimates that adherence to the checklist could prevent some 3.5 million deaths and major disabilities annually.

"There are 7 million deaths and disabilities due to complications of surgery every year around the world," said WHO Director-General Margaret Chan in a special message for the event. "Half of these could be avoided by following basic standards of care."

About 234 million major surgical procedures are performed worldwide each year, or 1 for every 25 human beings, according to a WHO-sponsored study published this week in the medical journal The Lancet. This is more than twice the number of childbirths, and "there are 10 to 100 times more complications due to surgery than to childbirth," said Dr. Atul Gawande, coauthor of the study and team leader for the development of the WHO Surgical Safety Checklist. Gawande's study estimates that 1 million people die during or immediately after surgery each year, and that half of these deaths could be prevented through safer practices.

Gawande said his team borrowed the checklist concept from the aviation industry, which has used pre-flight checklists effectively to reduce accidents resulting from human error. He said the team's short-term goal is to have the checklist used in 2,500 hospitals by the end of next year.

The Surgical Safety Checklist divides surgery into three phases: "Sign in," before anesthesia is administered; "Time Out," before skin incision; and "Sign Out," before the patient leaves the operating room. WHO recommends that a single "checklist coordinator" take responsibility for confirming that each member of the surgical team has completed his or her required tasks before the operation can begin. Among the issues covered in the checklist are:

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* Antibiotics have been administered within 60 minutes of the operation

(After the operation)

* All instruments, sponges and needles are accounted for

* Labeling of specimens

* Plans for postoperative care

WHO has begun testing the checklist's effectiveness through pilot projects in eight countries: Canada, India, Jordan, New Zealand, Philippines, Tanzania, the United Kingdom, and the United States. Based on preliminary data from 1,000 operations, "We have already seen significant reductions in deaths and disabilities," said Gawande.

"Early signs are that progress has already been made, and we have great hopes for this initiative," said Sir Liam Donaldson, chief medical officer of the United Kingdom and chair of WHO's World Alliance for Patient Safety.

Chan noted that surgery is an essential tool of health care that is not available on an equitable basis. The Lancet study estimates that 73.4 percent of all surgical procedures are performed in higher-income countries and benefit only 30 percent of the world's population. The poorest one-third of countries perform only 3.5 percent of all operations.

"We must also address the huge unmet need for surgery in low-income countries," she said. "The need for surgery is on the rise in the developing world because of the rise in chronic diseases."

The endorsements for the Surgical Safety Checklist came from medical and professional associations, government health agencies, hospitals, and patient advocacy groups in the Americas, Africa, Europe, and Asia, from countries representing some 75 percent of the world's population. In the United States, they include the American College of Surgeons, the American Society of Anesthesiologists, , the American Academy of Orthopaedic Surgeons, the American Academy of Otolaryngology-Head & Neck Surgery, and the Association of Perioperative Registered Nurses, among others.

Also present for the checklist launch was Dr. Kavita Patel, a healthcare expert who is a top aide to U.S. Senator Edward Kennedy. "We look forward to an international dialog on how we can improve not just surgical care but health care around the world," she said.

Sue Sheridan, leader of the Patients for Patient Safety arm of the World Alliance for Patient Safety, told participants in the launch: "Harm from surgery can happen to anyone, anywhere, regardless of the level of income or the type of government of the country you come from. Patients have the greatest stake. We challenge you to partner with your patients and inform your patients about the checklist, and make safe surgery a reality."